This is the final part of the series relating to iron, and will focus predominantly on how this effects athletes, when it’s time to supplement, symptoms to look out for and how you can keep yourself healthy. If you haven’t read parts I & II, covering how iron is absorbed, digested and regulated in the body, you can get part one here, and part two here.
Many people supplement blindly with an iron supplement, assuming that it is a silver bullet and flawless plan for treating and preventing anemia and iron deficiency. There are a number of drawbacks to using iron supplements, including the potential for gastric upset and the ease at which they can lead to toxicity levels. So what, then, can or should an athlete do to keep anemia at bay?
Just to reiterate the fact that there is a difference between iron deficiency and anemia, the former being a depletion in storage iron in the liver, spleen and bone marrow – resulting in depressed stores, decreases in decreased transport and an increase in TIBC, eventually leading to decreasing serum iron (see previous article if that doesn’t make sense). Iron deficiency starts to turn into anemia when ferritin levels drop below 12ug/L and your haemoglobin starts to fall out of range. Taking an iron supplement before this point will have no impact on performance, and one should wait until they are down near this 12ug/L range before supplementing with iron. Until you get to this stage, the best thing to do is to bolster your diet with foods rich in haem-iron and fortified products such as grains and cereals.
How can you tell if you are iron deficient or anemic? The simple and most effective answer is to get a blood test, it is a good idea to this annually anyway, or bi-annually if you are an elite athlete or in the at risk demographic (female endurance athlete). That really is the only definitive way to draw a distinction and place you in a distinct spot on the continuum of iron deficiency, but if your like me, you hate needles, and you won’t get a voluntary blood unless it is absolutely vital, what else can you do to keep tabs of your iron? There are a few physical and clinical signs you can look at, that may point you towards a conclusion.
Having pale skin, thinning hair, kyphosis (spoon shaped fingernails), pale conjunctiva (the red bit behind your eyelids) and noticing a decrease in training performance, by becoming short of breath much quicker and having a decreased exercise tolerance. Whilst this is useful info, it is important to note, that clinical and physical symptoms don’t usually precipitate until you are anemic or borderline. Alongside this, ferritin depression without drops in serum iron or haemoglobin, doesn’t actually impact on your ability to perform on the track, on the road or on the bike, as your oxygen transport capacity isn;t effected until your haemoglobin levels drop.
So, right now, what you can do is book a blood test (maybe wait until COVID has relaxed a tad), and ensure you get adequate iron intake, and pay special attention to the rich food sources and inhibitors, and start emphasizing this on a day to day basis. The biggest thing is to swap to wholegrain products over white options, getting your green veggies, pulses and nuts in on a day to day basis, consuming vitamin C with all these examples and if it’s possible, include lean red meat or offal 1-2 times per week, liver if you can hack it (I cannot).
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I hope you enjoyed this three part series on iron, it is a vital nutrient for any athlete or sportsperson to optimize in their diet, and can very easily and quickly unravel an athlete’s sporting ambitions. I would love to hear your feedback, if you found it useful or helpful, and if you think others can benefit from it, please share it!